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Fingers: Cysts and Pain

My middle-finger knuckles have tender growths. It hurts to push on the side of the joint. I'm 36 and have been climbing 17 years. The doctor said my knuckle bumps are related to Dupuytren's disease but I don't have any visible contractures on my palms or feet. X-rays and blood tests are normal. I also have plantar fasciitis in both feet.

Dennis Sander | Jackson, Wyoming

Thanks for the Photos. Those nodules look more out of place than Dubya in a pink jumpsuit. As the Aussie ex-prime minister once said, "Be alert, not alarmed."

The same applies to you, though I am not fear mongering! A biopsy of the cysts might be helpful. And see a rheumatologist.

I can't tell you what they are, but I can say I'd want to know. Their appearance is certainly cyst-like, and could be related to an arthritic condition or a connective tissue disorder. I might be wrong. I hope I am. I assume the blood tests looked for rheumatoid factor (RF) and, given a sero-negative result, rheumatoid nodules as related to rheumatoid arthritis (RA) are unlikely, though RA is still quite possible.

Given that the x-rays did not show joint degeneration, and that the blood tests were normal, the cysts are possibly related to a group of autoimmune arthritic disorders called seronegative polyarthropthies (no tell-tale RF in the blood). In many of these conditions other systems are often affected, for instance the skin (psoriasis), eyes (reactive arthritis) or bowel (inflammatory bowel disease).

The Dupuytrens diagnosis could be a possibility. I have never heard of related cyst formations like yours but, absurd as it sounds, I'm not the repository of all medical knowledge. Certainly, plantar fasciitis correlates with seronegative arthridities, as it is a connective tissue disorder itself.
Many cases of seronegative arthritis will go unclassified, as the genetics and their expression are peculiar to the affected person. If -- and when -- the condition evolves, it may subsequently be classed as a known autoimmune pathology such as rheumatoid or psoriatic arthritis, or more serious conditions such as systemic lupas erythematosus (SLE). Did I mention a rheumatologist?

The side-bending pain is indicative that the joint, or the connective tissue holding it together, is under some duress (metabolic or climbing). Clearly it is seronegative (which is of limited diagnostic value), non-destructive to your joints (so far), and not too disabling (let's hope that continues!), but I think this is likely to be a very early or very mild expression of an autoimmune arthritis.

Take this diagnosis with a full salt-shaker and, um, go see a rheumatologist. I mean, really, they could just be silly cysts on the backs of your knuckles!

RULES FOR THICK SKIN

Two words, one letter: Vitamin E oil.

Fresh calluses are good; caveman-thick ones aren't. A few swipes of 1,000-grit sandpaper, as needed.

Use lotion. Not moisturizer.

Wash off chalk as soon as you are done climbing.

HOW TO BUY CHALK

The white stuff comes in ball, block or crushed form, the difference between gumball, gum stick and ABC gum.

Some companies add drying agents that may be more expensive and wreak havoc on your epidermis.

USING CHALK

Crush chalk. It's just magnesium-carbonate, not Yellowcake.

Placing tickmarks on desert cracks is like using crib notes.

Always carry chalk in a Ziplock bag in your carry-on. The TSA agent who pulls out the suspicious bag will experience the happiest moment of his entire day ... until he realizes that it's not what he was hoping for.